NO BIG SHARP!

So this morning, while stressfully attempting an infusion change in between nursing GV and dressing myself for Mass (which we were of course running late for), GW walks in on me in our bedroom and begins to cry.  Yelling "No, Mama don't!" he crumples onto the floor in complex anxiety and begins a chorus of extraordinarily loud "NO! NO! NO!"  Rousing HB to abandon his half-eaten bowl of cereal, I quickly found myself the center attraction of an early Sunday morning family circus.

Since delivery, I've been able to swap my infusion site from the side of my torso back to my abdomen because my uterus is no longer in the way and, frankly, I find my stomach to be a much easier place to reach for insertion purposes.  Unfortunately, however, in making this switch I apparently forgot to debrief my toddler and he was absolutely horrified to see me putting a needle to a formerly identified "big ouch" spot.  Attempting to put me in time out so as to stop the wreck from unfolding before him, GW pointed at my belly and sobbed "no big sharp on the baby!!"

Despite his sister being bundled in her chair beside him and my obviously (dear Lord I hope it is obvious) smaller belly, GW apparently doesn't quite understand that the baby is no longer in my belly... which I must admit is either enough to make a person collapse from laughter or in tears.  HB picked up the crumpled kid and pointed out that GV is safely out of the way of the trajectory of the needle for my infusion change.   Sniffing and wiping his tears away with the back of his sleeve, GW looked from his sister back to my stomach with a perplexed look and, with an expression of at least some understanding, he changed his tune:  "Oh...  NO BIG SHARP FOR MAMA!"

Ah well... I wish I could acquiesce his request, but alas diabetes reigns and no amount of toddler passion will dethrone it.  I love that he is already protecting GV, even if he doesn't exactly know where she is, and I appreciate that his attempts to save me too are at least sealed with a make it better kiss.  It might not be the cure for insulin dependence, but if I have to stab myself then I will happily accept his cherry on top of an otherwise unpleasant experience.

Non-diabetic Nostalgia

The other night HB and I were debating the meaning of life (aka arguing whose turn it was to do the dishes) when my pump notified me of its depleted insulin reservoir.  As this is happening more and more frequently with my third trimester insulin resistance - about every other day or every two days - I absentmindedly grabbed my infusion change equipment and began to swap things out.  Amidst our deep, philosophical conversation, I went through every single step to reset my pump (rewound the piston, filled the new reservoir with insulin, hooked up and filled the new tubing, cleaned and prepped the new site and had the silserter charged for insertion) and only had one step left (actually inserting the new site) when HB started to uncontrollably laugh at me... 

Now, some of you might think it's cruel that my husband would laugh at me holding an almost two inch needle to my skin, but to be fair he does have good reason and here's why:  I have a new (admittedly somewhat ridiculous) routine when I do an infusion change. Typically taking five minutes or less to complete the whole process and move on with life, infusion changes now require a minimum of 30 - hopefully more - minutes to complete. 

This isn't because my uterus is too big to find a spot to put the new site or because the processes some how got more complicated.  Rather, it is because I am thoroughly enjoying the non-diabetic nostalgia that goes along with procrastination.  I looooove lying on the couch with my pump cast to the side, out of arms reach and pretending that I'm normal and don't need it to be attached to my hip (literally) 24/7.  I like that I can go to the bathroom without needing to coordinate my pump and my pants.  I like that I can put BOTH of my hands in BOTH of my pockets at the same time.  I like that if I wanted to be 100% in my birthday suit that I can be 100% not 98% dressed for success.  And I like that for those few minutes, I am completely free of the plastic shackles that bind me to a battery operated pancreas. 

Of course the end of my 30 minute trip down make-believe, dress-down lane ends with me regrettably whining for five minutes or so about having to come back to reality.  HB often asks me at this point if I want him to just insert it for me and the answer is always "no" because it is not that I need help or that I can't do it myself, it's just that it takes a bit to work up the desire to swallow that gigantic horse pill of "indefinite illness" that comes along with chronic diseases like this.  

I know the pump makes me healthy... I know being healthy keeps me happy... and I know being happy helps everyone around me be happy. BUT STILL, it'd be nice to just simply be happy and healthy without needing the pump.  

I miss being non-diabetic. A lot. 

Summer 2008:  Non-diabetic and simply self conscious.
(You try rocking a bikini and strategically wearing a pump at the same time!)

PS - I changed the infusion site that got this whole post topic started last night after a couple days of ultra sore, extremely sensitive to even the most minor touch pain.  Even before changing it I knew I'd have problems, but it turned out to be the ugliest, most gruesome site change I've had yet - gushing blood and unhappy ooze.  

Summer 2012:  my super sexy, you know you love it,
 ridiculously bloody infusion site.

So for anyone out there who has been diagnosed with pre-diabetes

 or has type 2, take a good look at this picture.  You have the ability to 

avoid this and - believe me - you want to.   

Holy OW.

So I had a feeling that this might happen sometime soon since I'm not putting on too much weight and the baby bump is getting bigger and harder, but alas inserting my infusion site has become a ridiculously painful experience.  I went to reinsert the site at a new place on the left side of my abdomen and instead of only going into the subcutaneous fat like it usually does, the needle bounced off my abs or uterus or something and seriously hurt like all get out.

Don't get me wrong, I have a really high pain tolerance and I am used to the pinch of a two inch needle jabbing my stomach every few days, but having a needle hit muscle or something more tender than fat is SO uncomfortable.  I've had to switch my infusion sites from the parallel lines next to my belly button to my sides since Baby has oh so lovingly deposited extra cushion for Mama there... So far the swap seems to be working out, but it makes lying on my side uncomfortable and carrying a purse is a bit painful when it bounces on the site.  Oh the joys of being a diabetic!

In other news, I've been completely on the ball with checking my blood pressure twice a day, weighing in daily and checking my urine for protein to make sure preeclampsia isn't setting in.  So far things are all within normal levels and that is great.  I'm going to be talking with my perinatologist at my next appointment about whether his concerns are for "IF" preeclampsia sets in or "WHEN" it sets in.  I'm not sure what to make of this high risk pre-preeclampsia routine since preeclampsia is frankly much more intimidating to me than any of the other complications we're having with this pregnancy.

The Preexisting Diabetes and Pregnancy book I've been reading has several many stories of women who had similar combinations of complications that had their babies as early as week 30 (which, by the way, is only six weeks from now)... scary. But face it, week 30 is better than week 24 -- and week 36 is even better than week 30!!  I registered for delivery this morning with the Fairfax INOVA Women's Center and I am glad that is ready to go just in case.  I've pretty much resigned myself to the expectation that we'll likely deliver earlier than optimal and that the use of a NICU may actually be required, but that is all in God's hands and I can only hope for the best.

Water.

So I got an excellent question the other day (thanks Bun) that hadn't even crossed my mind to write about:  how do I go swimming or take showers with my insulin pump?

Well, I don't. I don't swim or bathe while wearing the pump.  The pump is like any other non-waterproof electronic that runs off of a battery - it mechanically fails when it gets wet.  Given that I am fully dependent on it functioning... water and the pump just don't mix.

To work around this, the designers of insulin pumps understand that diabetics need to bathe and that some of the weird ones (obviously does not include me) even like this strange concept of swimming, so they created a quick release at the infusion site to disconnect the pump and tubing from the cannula.   This leaves the port in the skin until an infusion change is medically required (every two to three days), but allows the diabetic to remove the pump as necessary.

My current infusion site with the "male plug" inserted in
it; the red spots above the site are from previous cannulas -
the sites take a quite while to heal.

I can't speak to the exact set up of all insulin pumps, but what Medtronic does is provide a male and female "plug" for the pump tubing.  The female part of the plug attaches to the tubing and covers the needle while it is disconnected from the infusion site.  The male plug is inserted into the infusion site to cover the exposed end of the cannula - this prevents water, soap, whatever really from getting into the cannula and therefore your system.

The disconnected tubbing and the "female cover"

So that should cover the logistics of taking it off to be in water, now on to the consequences... well as I have explained else where, the pump delivers both a basal insulin (background insulin) and a programmed bolus of insulin to cover food.  With it disconnected, the body doesn't receive any insulin and the longer this goes on the higher a diabetic's blood sugar will go.  Without ingesting more carbs, blood sugars shouldn't go up quickly, but if the pump is left off for more than say 30 minutes BGs will progressively go up with the body's natural hormone production cycle.  It's not the end of the world to let your sugars go up temporarily in order to have fun and swim (did I just use "fun" and "swim" in the same sentence?), but if you're pregnant or sick, it's generally not worth the risk.

One additional interesting thing to point out about the use of artificial insulin and water is that a diabetic should not take a shower or bath in hot water until all of the active insulin in their system is depleted.  The reason for this is that hot water, like exercise, increases the efficiency of insulin and can cause hypoglycemia.  Since this should be avoided whenever possible, I guess that old rule of "no swimming after eating" actually has a bit of credibility.


Fair enough? Make sense? ... Marco?

Thank you so so much for the question!! And, please, if any reader has a question go ahead and shoot it my way in an email or just post a response/comment.  I'm more than happy to tailor future posts to people's interests or curiosities!

3:04 AM

I don't know if it is because of my growing baby bump that my back is bothering me as much as it is or if it is the manifestation of my stress knotting itself into reasons to lay awake tonight, but it's 3 o'clock in the morning and I've been wide awake for almost an hour.  The power light of our macbook was flashing like light house beckoning me safely home in the turbulence of my thoughts, so we'll see what this pitch-dark post makes itself out to be...

I almost dropped my pump again today when it got caught on GW's foot as I helped him step out of the truck.  Fortunately I had a free hand and was able to grab the cord before it fell too far from my infusion site and rip itself from my skin.  We were in a pretty remote part of VT at the time away from our rental place, so I didn't have a solution ready at hand were that to have happened.  I typically have an emergency SureT set up in the center console for times like this, but this wasn't my car and I don't carry around the necessary equipment to handle more than a hypoglycemic episode.  Before being a diabetic I didn't even carry a purse, I just threw my phone and wallet in the back pockets of my jeans and rolled out.  But now that I am out of college, need to carry glucagon and a requested matchbox truck or two for my son, I have no interest whatsoever in further conceding defeat by needing a full on diaper-bag, over-sized purse to replace the one I already lug around along with my book bag.

While I was surprisingly coordinated today in my pump saving reflexes, I unfortunately haven't been quite so quick or quite so lucky at other times.  One time, I turned around to reach for GW in his car seat and the infusion site I had placed on my oblique caught on the seat belt buckle and tore out... Another time, walking down the hallway of our home while carrying a bin of clean laundry I failed to notice my pump tubing loop the door nob to the bedroom and riiiiiiiiip there it went... While lying on the floor playing with one of our dogs, Gracie, she snagged a loose end of cable with her nails and spastically tugged it out in a playful bounce.  And there was this other time when snuggly-sleeping with HB that the cord somehow got wrapped around his arm and my site went with him when he rolled to his other side.  Let me tell you... between the shock of having a cannula pulled out of you unexpectedly and the pain of the tape detaching itself from your skin, it is not a fun experience to go through!!

I don't know if any of you have had an IV administered to you before, but for those of you who have, do you remember the extra caution that went into your every movement so as to prevent the tubing from becoming snagged on anything that might require the nurse to reinsert the IV?  Perhaps I simply have a more innate distrust of that tape stuff they use than other people do, but each time I've have an IV my motions are far fewer in number and much more deliberate in purpose than they are normally.  Well, wearing an infusion set is to one degree or another similar to this - but because it is always there, it's easy to forget about it or to not notice when the tubbing is hanging out farther than it really ought to.    So while I am extremely attentive to the perceived inability to flex my elbow while wearing an IV, I am sometimes blissfully unaware of my diabetes to my own detriment... blissful ignorance replaced with an instantaneous reminder of reality. Oh joy.

That reminds me of those random moments when sitting down to a meal that I absentmindedly go to pick up my sandwich and enjoy the food in front of me without remembering the loaded sentence "I'm a diabetic" first.  It's absolutely wonderful to take that bite and enjoy the quality bread and other ingredients without concern, but when the thought hits that I am savoring unaccounted for carbs, I have to put my contentment in normalcy aside, lay down my food and be the disease again.  In a lot of ways I am envious of the other type 1s who were diagnosed as kids and don't remember what it was like to not be diabetic... I spent 24 years becoming accustomed to life and eating as a healthy person and it's sometimes very surreal to realize my life has been divided into a before and after shot.

So while you're sitting there enjoying your bowl of Cheerios tomorrow morning (that is 20 grams per cup of regular - non-honey nut - Cheerios and 13 grams per 8 oz of milk), take a moment to realize how nice it is to be healthy... I didn't appreciate it enough before I got sick and hind sight being what it is, it would have been nice to make the connection of how good I had it before sugar became a problem.

Infusion changes

I'll keep this post relatively short, but I had to do an infusion change today and despite the fact I've been using this particular infusion set for several months now I cannot get over the nerves of inserting it.

There is a "smiley face" on my right thigh
just under my black pump clip in my
pocket - that is a SureT infusion site.

Initially when I went on the pump, Medtronic (my diabetes supply company) suggested that I use the infusion set called a "SureT" that has secondary attachment site on surface of your skin.  The purpose of the second attachment and the benefit of this specific set is that if your pump gets caught or is pulled by something (i.e. a toddler...) the second site will detach and the infusion site remains intact in your subcutaneous fat.  While this worked beautifully for me for a while, when I really ramped up my training for running and started to notably decrease my body fat percentages the 5 mm needle that remains in your skin with this infusion set design would begin to jab my muscles and make movement - walking, let alone running - very painful.

Of course the people at Medtronic thought it was particularly funny when I called to say "I don't have enough fat to wear this infusion set any more," but all irony and joking aside they ultimately agreed that I needed to change designs for comfort.

No longer using my son as the driving factor for which infusion set I use,  I had several many new options to pick from.  Ultimately picking the most "athlete friendly" option, I've been on a set called the "Silhouette" for the past eight or nine months.  The big difference between this one and the SureT is that this set uses a cannula for insulin injection.  The benefit of using a cannula is that it is a plastic tube rather than sharp metal and instead of being inserted vertically into the skin is "injected" at a 45 degree angle into the subcutaneous layer.

Much better, right?

Well... yes, but no.  The problem with this particular cannula is that it requires a 1.5 inch needle on a spring loaded "serter" to be placed accurately...  No matter how many times I've done this (every three days) or how many times I remind myself that it really doesn't hurt all that much, it still scares the boohockey out of me to press that action button, hear the twang of release and send this needle surging into my abdomen.

I must admit that I am half looking forward to the point in this pregnancy where I've put on enough excess weight and fat to be able to swap back to the SureT and avoid this particular self-mutilation for a few months... but then again I want to get back to running, so that respite wont last too long I hope.  Of course I have an amneocentesis or two to look forward to toward the end of the pregnancy to check on Baby's lung development, so it looks like I'm doomed to large gauge needles regardless!

Well, that is enough thinking about needles and stabbing oneself for one night.  Charming topic, I know, but it's a reality I deal with on a regular basis.